Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 26
Let's Talk About That
be to determine which patients will most benefit
from orthodontic intervention. Close examination of the existing literature on maxillary expansion treatment of OSA in children displays the
same variability of treatment effect.2
PT: At present, where do you see the orthodontist
fitting into the management of patients with
SDB?
BP: I think it starts with better detection and
recognition of the condition in our patients. As
part of our standard and routine medical history,
orthodontists should be screening for SDB symptoms in their patients. This can be in the form of
adding questions regarding the common associated symptoms such as snoring, restless sleep,
witnessed gasping during sleep, or behavioral
issues like hyperactivity, inattention, grumpiness,
or excessive sleepiness.3 Follow-up and referral to
a physician should be made if the patient history
suggests SDB.
We're not yet at a point where we can suggest
maxillary expansion solely for the purpose of
eliminating sleep-related breathing issues. In any
particular patient it might help, but it might
not. Maxillary expansion for the purposes of SDB
management should be performed in conjunction with monitoring from a physician, and possibly with objective sleep testing.
PT: Which areas of research within orthodontics
and sleep medicine need to explored?
BP: A great place to start would be to conduct
controlled clinical trials examining the effectiveness of maxillary expansion treatment for OSA
so that we can make successful treatment more
predictable. All currently published data on maxillary expansion treatment for OSA has been performed in the absence of a control group. This is a
very important consideration because the disease
will regress spontaneously in a large percentage
of affected children,4 making it impossible to
accurately assign improvement in symptoms to
the actual expansion treatment. As hospitalbased polysomnograms (sleep tests) would be
needed to determine treatment effectiveness,
overcoming the financial and practical barriers of
this requirement makes such a study challenging
to carry out.
PT: When treating OSA in children with Class II
malocclusion, is there any evidence that a functional appliance (anterior mandibular reposition)
would improve the airway, similar to the way
adults are currently being treated?
BP: Unlike the number of case series and observational reports examining maxillary expansion,
there is much less data available for functional
appliances as a treatment for OSA in children.
One needs to also keep in mind the challenge
with studying the airway in growing children is
that the airway volume increases significantly in
the late mixed dentition, due both to general
growth and the natural regression of the adenoids and tonsils at this time. Therefore, it can
be challenging to differentiate changes due to
treatment from that of normal growth. The more
appropriate measure of treatment effect would
be an assessment of airway function by way of
polysomnography or overnight sleep test.
Perhaps the best study on the question of functional appliances was conducted by Villa et al in
2002,5 which was a six-month randomized controlled trial investigating the clinical usefulness
and tolerability of monoblock-type appliances in
children with OSA. The reported results were
quite promising as the treated children saw a
significant decrease in symptoms (though only
50% decreasing to normal levels) with no similar
changes in the control group. The use of a control
group and the pre- and post-treatment sleep
tests are significant strengths of this study; however, the small sample size of only 14 treated
continued on page 32
26
PCSO Bulletin Spring 2018
Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2018
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 1
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 2
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 3
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 4
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 5
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 6
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 7
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 8
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 9
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 10
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 11
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 12
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 13
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 14
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 15
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 16
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 17
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 18
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 19
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 20
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 21
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 22
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 23
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 24
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 25
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 26
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 27
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 28
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 29
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 30
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 31
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 32
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 33
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 34
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 35
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 36
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 37
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 38
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 39
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 40
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 41
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 42
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 43
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 44
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 45
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 46
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 47
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 48
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 49
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 50
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 51
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 52
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 53
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 54
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 55
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 56
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 57
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 58
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 59
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 60
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 61
Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 62
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